Author + information
- Ankeet S. Bhatt, MD, MBA,
- Adam D. DeVore, MD, MHS and
- Adrian F. Hernandez, MD, MHS∗ ()
- ↵∗Department of Medicine, Duke Clinical Research Institute, Duke University School of Medicine, P.O. Box 17969, Durham, North Carolina 27705
We appreciate the interest in our study (1) and agree with Drs. Barrios and Escobar that the findings of underuse of influenza and pneumococcal vaccination for patients hospitalized with heart failure have important implications globally (2). We also agree with them that that our findings of an association between hospital wide performance on vaccination and performance on other guideline-directed therapies for heart failure is intriguing. In addition to representing the lack of therapeutic inertia, these findings may also be secondary to more systemic differences among centers, including the development of information technology platforms and heart failure disease management programs that facilitate comprehensive heart failure care, including vaccination.
Although the optimal timing and dose of vaccination in patients with heart failure are not currently well-studied, these programs may be useful in promoting early, routine, vaccination practices that can be further refined as the evidence-base grows. The large randomized trial INVESTED (INfluenza Vaccine to Effectively Stop Cardio Thoracic Events and Decompensated Heart Failure) will offer important insights into the optimal dosing of influenza vaccination in patients with a history of myocardial infarction or hospitalization for heart failure (1).
Further investment in identifying, replicating, and testing the strategies used by more successful centers may improve the rates of vaccination and may also be applicable to other evidence-based therapies for heart failure. Combined with stronger recommendations, as the investigators state, and increased accountability, these programs have the ability to improve the lives of patients with heart failure. This investment would be well worth it.
Please note: Dr. Devore has received research funding from Akros Medical, the American Heart Association, Amgen, Bayer, Intra-Cellular Therapies, Luitpold Pharmaceuticals, the National Heart, Lung, and Blood Institute, Novartis, and PCORI; and has been a consultant for Novartis. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
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